糖尿病黄斑水肿患者白内障围手术期应用抗VEGF药物的疗效观察  

Efficacy of anti-vascular endothelial growth factor drugs in diabetic macular edema patients during the perioperative period of cataract surgery

作　　者：刘宏卓 王培玉 方梦园 万文萃[1] LIU Hongzhuo;WANG Peiyu;FANG Mengyuan;WAN Wencui(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)

机构地区：[1]郑州大学第一附属医院眼科,河南省郑州市450052

出　　处：《眼科新进展》2022年第2期128-131,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金青年基金项目(编号8210040956)。

摘　　要：目的观察糖尿病黄斑水肿(DME)患者真实世界中白内障手术前后玻璃体内注射抗血管内皮生长因子(VEGF)药物的效果,进而观察DME患者白内障围手术期积极接受玻璃体内注射抗VEGF药物疗效。方法回顾性临床队列研究。回顾性分析2018年1月至2021年5月在郑州大学第一附属医院眼二科接受白内障超声乳化手术和玻璃体内注射抗VEGF药物的DME患者。88例(88眼)患者术前6个月内诊断为DME合并白内障而行白内障手术,并接受玻璃体内注射抗VEGF药物≥1次。预后指标主要包括术后3个月、6个月视网膜下液或视网膜内液的发展、抗VEGF药物注射时间、抗VEGF药物注射次数、最佳矫正视力(BCVA)和黄斑中央凹厚度(CST)。结果患者白内障手术前BCVA(logMAR)为2.40±0.49,术后1个月为1.02±0.70,术后6个月为0.80±0.63,术后BCVA较术前均有显著改善(均为P<0.05)。所有患眼术前黄斑CST为(335.364±54.44)μm,白内障术后1个月、6个月黄斑CST分别为(226.37±84.85)μm和(213.63±91.92)μm,差异无统计学意义(P>0.05)。术前光学相干断层扫描检查发现有视网膜内液或下液88眼(100.00%),术后40眼(45.45%)出现新的或增加的视网膜内液或下液,但有新增积液者黄斑CST在手术前后无明显差异(P>0.05),而术后视力较术前明显提高(P<0.05)。结论在真实世界里,合并白内障的DME患者可行白内障手术,只要规律进行抗VEGF治疗,DME的恶化不会影响患者的BCVA。Objective To investigate the effect of intravitreal injections of anti-vascular endothelial growth factor(VEGF)drugs before and after cataract surgery in patients with diabetic macular edema(DME)in the real world and the efficacy of anti-VEGF drugs during the perioperative period.Methods This study was a retrospective clinical cohort study.All patients who underwent cataract surgery and intravitreal injection of anti-VEGF drugs in the First Affiliated Hospital of Zhengzhou University from January 2018 to May 2021 were analyzed.There were 88 patients(88 eyes)diagnosed as DME combined with cataract within 6 months before surgery receiving cataract surgery and at least one intravitreal injection of anti-VEGF drugs.Outcome measures included the development of subretinal or intraretinal fluid at 1 and 6 months postoperatively,injection time,number of injections,best corrected visual acuity(BCVA),and central subfield thickness(CST).Results Preoperative BCVA(logMAR)was 2.40±0.49,and postoperative BCVA(logMAR)was 1.02±0.70 and 0.80±0.63,respectively,at 1 month and 6 months after surgery.Postoperative BCVA improved significantly in all eyes(all P<0.05).CST of all eyes was(335.364±54.44)μm,(226.37±84.85)μm,and(213.63±91.92)μm before surgery,1 month and 6 months after surgery,respectively.The difference was not statistically significant(P>0.05).Preoperative optical coherence tomography showed fluid in 88 eyes(100.00%).Forty eyes(45.45%)developed new or worsened subretinal or intraretinal fluid,while for these eyes,there was no significant difference in CST before and after surgery(P>0.05),and the postoperative visual acuity significantly improved(P<0.05).Conclusion In the real-world setting,DME patients with cataract can receive cataract surgery,and their BCVA will not be affected by worsening DME as long as they follow the anti-VEGF treatment.

关 键 词：糖尿病黄斑水肿 白内障手术 抗血管内皮生长因子 最佳矫正视力 黄斑中央凹厚度 

分 类 号：R774[医药卫生—眼科]